Medical Summary Report
January 17, 2017
Re: Mr. Flick
DOB: 00/00/0000
SS No. 000-00-0000
Dear DDS Examiner:
Introduction
Mr. Flick is a 49-year-old divorced, Caucasian chronically homeless male. Mr. Flick was
recently released from prison and was receiving benefits prior to his incarceration, but was
incarcerated for 18 months and had his benefits terminated. Mr. Flick states, “I didn’t tell them
that I went out of county and they need to keep up with where I am.” Mr. Flick is short and of
average build. He is disheveled and has poor hygiene. He wears dirty pants and a grungy jean
jacket with a threadbare plaid collared shirt underneath. He wears a blue cap that sits barely on
top of his gray hair. His shoes have holes with his toes poking out. When he walks he shuffles
his feet across the ground with a limp. Mr. Flick does not have any teeth, which makes it difficult
to understand what he is saying. He does have a speech problem, where he is unable to
pronounce the letter “R” and he stutters frequently. It is noted in records, that this writer did not
obtain, that he has a very low IQ. The Disability Determination Service (DDS) should have these
records from Mr. Flick’s prior file.
It was difficult to get information from Mr. Flick due to his inability to understand many of the
questions the first time asked, poor insight, and difficulty expressing his symptoms. During the
interview, Mr. Flick states in a disorganized and stuttering manner:
“I g…g…got a lot of mood problems [problems]...I g…get upset a lot if I’m not on my
m…m…meds…I can tell when I’m not on my med cause I cain’t talk right and
stuff…I…f…f…feel like their…um…hearing things sometimes telling me to hurt
somebody…I’m just stupid…stupid…stupider than everyone…When I was young I used
to be real good in my life. I don’t know what happened. When I caught that sex charge
everything started turn…turning for me…It was the 80’s or something…You know the
80’s when I…I…worked to crush rocks…People are bad to me and make…make…make
fun of me…I don’t like being with them because they try to get me too much…I got to
get away from here and say hi to my family in another county…I got to get out of here.”
According to Prison records from 7/1/2008 to 1/27/2011, Mr. Flick has been diagnosed with an
Axis I diagnosis of Mood Disorder NOS, Hypertension and GERD. Mr. Flick has been treated at
other facilities and the DDS should have those in Mr. Flick’s prior file. His current diagnosis
from Dr. Lime is Major Depression, Generalized Disorder and Speech disorder-rule out.
Mr. Flick’s symptoms include disorganized thoughts, mood swings, easy distractibility, auditory
and visual hallucinations, grandiose thoughts, loose associations, severe paranoid thinking,
suicide attempts, anger outbursts, decreased energy, severe social anxiety, and difficulty
1
concentrating and focusing with frequent confusion.
When asked about his diagnosis, Mr. Flick states in a suspicious tone and looking at the table, “I
just mood swing. I don’t understand things…I don’t understand the bad things…I get the
weird…You know the weird things sometimes.”
Mr. Flick’s mental health symptoms significantly impair all areas of functioning. These
impairments have had a direct affect on his ability to maintain stable housing when not in Prison
since 2006 and employment since 1986.
Personal History is not being summarized because this is in his prior file
Medical Records
Mr. Flick has been receiving treatment for his mental health issues “for years” although this
writer did not obtain those records since the DDS already has them. This writer requested records
from the County Correctional Facility, since those are the only records DDS has not obtained.
Prison Records
County Correctional Facility
Mr. Flick was arrested 7/1/2008 for Violation of Sex Offender Registry. While incarcerated at
the County Correctional Facility, Dr. Thomas, MD treated Mr. Flick. Dr. Thomas diagnosed him
with an Axis I diagnosis of Mood Disorder NOS. Dr. Thomas treated Mr. Flick with Depakote
500mg and Loxitane 10mg.
On 12/2/2010 Mr. Flick attempted to commit suicide. Records state, “I/M escorted to medical
per security. C reports I/M attempted to hang self…I/M reports he was placed in [segregation]
due to issues with a gang member. I/M reports he has been increasingly depressed until he
couldn’t take it anymore. He placed a thin T-shirt like material around his neck and attempted to
hang himself. I/M is noted to have some mild red marking to neck area.”
Other records were difficult to read, although to this writer’s knowledge, there were no other
major concerns while incarcerated.
He was released on 1/27/2011 to the city shelter.
Mental Status Exam
Dr. Kathy Lime performed a current mental status exam on 2/11/2011 that will be included with
the submission of this report. Dr. Lime states, “Speech was somewhat impaired but we had no
problems communicating. Short and long term memory were consistent with overall ability.
Ability, fund of knowledge and insight were below normal…Mood and affect were nervous and
anxious…He was not able to complete serial 3s or 7s but was able to count backwards from 100
by 1s…He indicated that he has not used alcohol or drugs in 10 years…He feels down and very
sad when depressed. He described being despondent but didn’t use that word. He feels very
stressed and he described being overwhelmed…He has had a lot of anger and irritability. He is
often upset. He feels ‘off’ at times around people. He has heard voices that are not there at night.
He has heard voices telling him to hurt people. They come from outside his head. He does not
2
recognize the voices…He knows they are voices.” In Dr. Lime’s conclusion, she states, “He has
an inability to manage money, medication, and travel. He has moderate problems with social
stress and social decision making.” Dr. Lime diagnosed Mr. Flick with Major Depression
disorder, Generalized Disorder and Speech disorder-rule out.
Functional Information
Mr. Flick displays significant impairments in all areas of functioning. Due to the symptoms of
his mental illness, specifically his anxiety, mood swings and extreme paranoid thinking, Mr.
Flick has been unable to maintain stable housing when he is out of jail since 2006 and
employment since 1986.
Understand, Remember and Apply Information
When this writer asked Mr. Flick if he is able to go to the grocery store on his own for food, he
states, “I can’t read or write because I got a 7th grade completed…Can’t do things alone…I got a
friend at this place [Drop in Center] who helps me with things. He’s real nice.” When asked if he
is able to complete daily chores, he states while looking at the table, “Don’t remember always.”
When asked if he is able to manage money and medications, he states, “I don’t do money cause I
can’t count…I put my pills in my pocket in the morning and try to remember to take them.” Mr.
Flick relies on the drop-in center staff to remind him to take his meds, as he “locks my meds up
in the office so they give them to me.” On one occasion, Mr. Flick forgot to turn his medication
into the drop-in center staff, and he lost it. He was without it for 4 days before he reported it to
staff.
When asked if there are any regular things that others can do that he can’t do so well, he states
while looking at the ceiling and shaking his head, “Read, write, count…Most people went to
school.” Dr. Lime also states in her MSE, “He remembers to take his medications with a great
deal of help from a friend…He cannot count money, write checks or pay bills. He cannot read
his own mail and can’t fill out paperwork and forms…He feels uneasy on the wheel and feels
that he might lack concentration now. He can take the bus only with assistance…He feels that he
lacks ability to follow instructions now for daily decisions. He falters on minor things. He has
trouble sleeping.”
As previously mentioned in this report, Dr. Lime states in her MSE (dated 2/11/2011), Mr.
Flicks’ “Ability, fund of knowledge and insight were below normal…Mood and affect were
nervous and anxious…He was not able to complete serial 3s or 7s but was able to count
backwards from 100 by 1s…”
Due to the symptoms that Mr. Flick experiences from his mental illness, he displays significant
limitations in the ability to understand, remember and apply information.
Interact with Others
Mr. Flick does not have a lot of family support. He states, “I ain’t got too much family left. I
ain’t talked to them since I been locked up…They in another city. They are nice, but far away…I
don’t c…c…c…care for people too much, I stay away and to myself…They argue with me, and I
a…argue with them.” When asked if he has any problems with relationships, he states as he
3
laughs in a flat manner, “I’d married three times and I was always the good one…I’d been
treated bad…I married the same lady two times, and one…one…one time in prison I married her
in 2000…I got two sons that…that think I’m a brunt…You know…not smart I guess…I don’t
talk to them.” This writer has noticed while he is at the drop-in center during the day, he is
always sitting alone and not talking with others. On one occasion, Mr. Flick was without his
medications and he was yelling very loud at this writer blaming this writer for his medications
being lost. Mr. Flick required extreme redirection and this writer asked Mr. Flick to come outside
for a walk and he states, “I’m too sorry for all this…I just feel weird…Just real weird.” It was
very obvious that other members were bothered by his loud aggressive tone with this writer. This
writer was able to calm Mr. Flick down and connect him with drop-in center staff to assist him
with medications. Dr. Lime states in her MSE, “He was close to his mother but not as much with
his father…He tends to argue a lot in relationships…He used to fish and hunt but that was a long
time ago. He is able to handle a very light amount of stress but not a normal amount of stress. He
is not able to make social decisions…He has moderate problems with social stress and social
decision making.”
Due to the symptoms that he experiences from his mental illness, Mr. Flick displays significant
limitations when interacting with others.
Concentrate, Persist or Maintain Pace
Mr. Flick reports having a difficult time staying focused sometimes. He states, “I…I…I get
confused sometimes…I got a hard time sometime.” Mr. Flick does not seem to forget
appointments, as he becomes extremely fixated on them. Before every appointment with Mr.
Flick, he calls this writer at least three to four times to remind this writer about the appointment.
It is unclear if a friend is reminding him of the appointment or if he is remembering on his own.
When asked if he becomes distracted easily, he states, “I get distracted when I get moody
swingy…I get mad a lot…I get nervous at the Service Center cause there is so many people…so
many there that I get quivery sometimes…I can…do some things sometimes.” Dr. Lime states in
her MSE, “He can focus and concentrate…He can understand simple instructions…Short and
long term memory were consistent with overall ability. Ability…below normal.”
Due to the symptoms that he experiences from his mental illness, Mr. Flick displays significant
limitations in his ability to concentrate and persistently maintain pace.
Adapt or Manage Oneself
Mr. Flick is currently living at the city shelter. Mr. Flick has been in and out of prison “my whole
life” but since 2006, he has been at the city shelter “when I get out. No place…place…place to
go…It will put ya there…I’m stupid sometimes…Feel real stupid. People make fun too.” When
asked if he is able to manage money and medications, he states, “I don’t do money cause I can’t
count…I put my pills in my pocket in the morning and try to remember to take them.”
Mr. Flick does not currently take care of any other people or pets. Mr. Flick can bathe, dress and
use the toilet on his own. When asked how often he bathes, he states, “Every couple days. I
do…do…don’t do it at the shelter ‘cause they too mean there…I come to Service Center [drop-in
center]…They nice up here, really.”
4
Due to the symptoms that he experiences from his mental illness, Mr. Flick displays functional
limitations in managing his self-care.
Conclusion
Mr. Flick is a 49-year-old divorced, Caucasian chronically homeless male. According to Prison
records from 7/1/2008 to 1/27/2011, Mr. Flick has been diagnosed with an Axis I diagnosis of
Mood Disorder NOS, Hypertension and GERD. Mr. Flick has been treated at other facilities and
the DDS should have those in his prior file. Mr. Flick’s symptoms include disorganized thoughts,
mood swings, easy distractibility, auditory and visual hallucinations, grandiose thoughts, loose
associations, severe paranoid thinking, suicide ideations/attempts, anger outbursts, decreased
energy, severe social anxiety that results in hallucinations, and difficulty concentrating and
focusing with frequent confusion. The impairments that are caused by his mental illness have
had a direct affect on his ability to maintain stable housing out of prison since 2006 and
employment since 1986. If Mr. Flick were to be approved for benefits, it is this writer opinion
that he would need assistance with managing his money due to his poor insight and constant
confusion.
If you have any questions, please contact Mary Smith at 111-111-1111 or Dr. Kathy Lime at
222-222-2222.
Sincerely,
Mary Smith
SSI/SSDI Homeless Outreach Project
Dr. Kathy Lime
Consulting Psychologist
5